Plantar fasciitis was previously believed to be inflammation of the fascia near its insertion on the heel bone. The suffix (-itis) means inflammation. Studies, however, reveal that changes in the tissue associated with the injury are degenerative and not related to inflammation, at least not in the way most people typically think of inflammation. Sudden onset of heel pain may indeed be related to acute inflammation. For persistent heel pain the condition more closely resembles long-standing degeneration of the plantar fascia near its attachment than inflammation. This could explain why anti-inflammatory medications and injections have been unsuccessful at treating it. But there is more to heel pain than just the plantar fascia.
There are a number of plantar fasciitis causes. The plantar fascia ligament is like a rubber band and loosens and contracts with movement. It also absorbs significant weight and pressure. Because of this function, plantar fasciitis can easily occur from a number of reasons. Among the most common is an overload of physical activity or exercise. Athletes are particularly prone to plantar fasciitis and commonly suffer from it. Excessive running, jumping, or other activities can easily place repetitive or excessive stress on the tissue and lead to tears and inflammation, resulting in moderate to severe pain. Athletes who change or increase the difficulty of their exercise routines are also prone to overdoing it and causing damage. Another common cause of plantar fasciitis is arthritis. Certain types of arthritis can cause inflammation to develop in tendons, resulting in plantar fasciitis. This cause is particularly common among elderly patients. Diabetes is also a factor that can contribute to further heel pain and damage, particularly among the elderly. Among the most popular factors that contribute to plantar fasciitis is wearing incorrect shoes. In many cases, shoes either do not fit properly, or provide inadequate support or cushioning. While walking or exercising in improper shoes, weight distribution becomes impaired, and significantly stress can be added to the plantar fascia ligament.
Symptoms of plantar fasciitis can occur suddenly or gradually. When they occur suddenly, there is usually intense heel pain on taking the first morning steps, known as first-step pain. This heel pain will often subside as you begin to walk around, but it may return in the late afternoon or evening. When symptoms occur gradually, a more long-lasting form of heel pain will cause you to shorten your stride while running or walking. You also may shift your weight toward the front of the foot, away from the heel.
Your doctor may look at your feet and watch the way you stand, walk and exercise. He can also ask you questions about your health history, including illnesses and injuries that you had in your past. The symptoms you have such as the pain location or when does your foot hurts most. Your activity routine such as your job, exercise habits and physical activities preformed. Your doctor may decide to use an X-ray of your foot to detect bones problems. MRI or ultrasound can also be used as further investigation of the foot condition.
Non Surgical Treatment
In the early stages of plantar fasciitis resting the foot may ease the pain. Medication to reduce inflammation should help but should only be used short term. Strapping may temporarily reduce the pain. All of the above therapies are only temporary measures and the pain is likely to reoccur if the cause of the abnormal pressure which has triggered the plantar fasciitis has not been identified. In order to establish the cause of the plantar fasciitis a biomechanical assessment may be required.
The most common surgical procedure for plantar fasciitis is plantar fascia release. It involves surgical removal of a part from the plantar fascia ligament which will relieve the inflammation and reduce the tension. Plantar fascia release is either an open surgery or endoscopic surgery (insertion of special surgical instruments through small incisions). While both methods are performed under local anesthesia the open procedure may take more time to recover. Other surgical procedures can be used as well but they are rarely an option. Complications of plantar fasciitis surgery are rare but they are not impossible. All types of plantar fasciitis surgery pose a risk of infection, nerve damage, and anesthesia related complications including systemic toxicity, and persistence or worsening of heel pain.
While there are no sure ways to prevent plantar fasciitis, these prevention tips may be helpful. Keep your weight under reasonable control. Wear comfortable, supportive shoes. Use care when starting or intensifying exercise programmes.